UPPER RESPIRATORY INFECTIONS It may become complicated by a bacterial infection. Sinus congestion causes an increase in sinus drainage, post-nasal drip, throat irritation, HA, and earache. Adult Health Nursing 7th Ed

ACUTE RHINITIS Coryza, “common cold” Etiology and pathophysiology -An inflammatory condition - mucous membranes of the nose and accessory sinuses -Caused by one or more viruses. -signs/symptoms-evident 24-48 hours after exposure Characterized by edema of the nasal mucous membranes

ACUTE RHINITIS If uncomplicated, it subsides in a week. CLINICAL MANIFESTATIONS Sinus congestion -increased sinus drainage - postnasal drip - throat irritation - headache - earache Productive cough. Fever. If uncomplicated, it subsides in a week.

Acute Rhinites SUBJECTIVE: 1. Pt. complaints of symptoms OBJECTIVE: 1. Color , consistency of nasal discharge. 2. Visual exam the throat for redness, edema, local irritation. 3. Presence and duration of fever

Diagnostic Tests Throat and sputum cultures.

MEDICAL MANAGEMENT -prevention of complications. -Accurate diagnosis -prevention of complications. -No specific treatment -Aspirin or Tylenol - analgesia/fever -Cough suppressant - dry, nonproductive cough. -Cough expectorant - productive cough -antibiotic - bacterial infection . Vit C, lozenges

NURSING INTERVENTIONS -Promote comfort. -Encourage fluids. -Apply warm, moist packs to sinuses.

PATIENT AND FAMILY TEACHING -proper hand washing -disposal of tissues -limit exposure to others during the first 48 hours -check body temp. every 4 hours.

Ineffective airway clearance, related to nasal exudate NURSING DIAGNOSIS Ineffective airway clearance, related to nasal exudate Health-seeking behaviors: illness prevention, related to preventing exacerbation or spread of infection AHN p419 Fluids to liquify secretions and aid in expectoration. Use vaporizer to moisten mucous membranes. Health maintenance behaviors. (proper hand washing, disposal of used Kleenexes, etc. 2.Adequate fluids and nutrition.

ACUTE FOLLICULAR TONSILLITIS Etiology and pathophysiology -Acute inflammation of the tonsils. -Result of an air- or food borne bacterial infection -often Streptococcus -Can be viral

Acute Follicular Tonsilitis -If it is caused by Group A β-hemolytic Streptococci, sequelae can occur: -Rheumatic fever -Carditis -Nephritis. -Most common in children. Sequelae: resulting from a disease or condition

CLINICAL MANIFESTATIONS -sore throat -fever -chills -malaise -enlarged, tender, cervical lymph nodes. -general muscle aching. -Labs -CBC reveals an increased WBC count.

MUSCLE ACHE, ENLARGED CERVICAL NODE

-patient complains of: - severity of the sore throat - ear pain ASSESSMENT SUBJECTIVE: -patient complains of: - severity of the sore throat - ear pain - headache -joint pain

OBJECTIVE DATA: 1. Visual exam: - throat secretions - enlarged, reddened tonsils.

DIAGNOSTIC TESTS 1. Throat culture 2. CBC to check the WBC count With bacterial infection, WBC can rise to 10-20,000 Throat culture will identify the causative microorganism, most commonly β-hemolytic strep.

MEDICAL MANAGEMENT -Early antibiotics - specific to the bacteria. -Tonsillectomy and adenoidectomy (T&A) - usually done in people who have recurrent attacks -Medications: - antipyretics, analgesics, and antibiotics -Warm, saline mouth gargles. , Chloraseptic spray, lozenges T&A local or general

NURSING INTERVENTIONS -Thorough oral care - promotes comfort - reduces/prevents infection. Post-OP care: IV fluids until the nausea subsides, then the pt. may begin drinking ice cold fluids slowly. Advance the diet to soft liquids, then to a regular diet.

NURSING INTERVENTIONS -Post-operative - observe for: - bleeding. - fever - check V.S. - provide physical and emotional comfort - postioning - support - pain medication - apply an ice collar to the neck - comfort and vasoconstriction. Watch for s/sx; elevated temp

Nursing Diagnoses Pain, related to inflammation/irritation of the pharynx. Risk for deficient fluid volume, related to inability to maintain usual oral intake because of painful swallowing Risk for aspiration, related to postoperative bleeding Assess the degree of pain and the need for analgesics. Offer warm, saline gargles, ice chips, and/or ice collar. Document

Nursing Interventions -Maintain patent airway - keep the pt. lying on his side - prevents aspiration. -Observe for frequent swallowing - may indicate bleeding - check the back of the throat with a flashlight for blood trickling down. (if there is vomitus, check the color. Dark brown may indicate swallowed blood.) (skin turgor, mucous membranes, urine output). (ice cream, sherbet, puddings, yogurt, etc)

Nursing Interventions - assess hydration status. - encourage ice chips, popsicles, and cold fluids. - avoid citrus fluids -may irritate the throat - measures to avoid vomiting

VOMITING

Patient and family Teaching - Complete the prescribed antibiotic - Tonsillectomy patient - instruct on the dietary precautions. - avoid clearing his throat, vigorous coughing, sneezing, or nose blowing after surgery for 1-2 weeks. - may cause bleeding Post op- IV until nausea gone,then drink ice cold liquids then custard & ice cream then normal. Ice collar comfort measures .; watch for hemmorhage

Patient and Family Teaching - notify the PCP if there are any complications. - void ASA or other blood-thinning medications

LARYNGITIS Etiology/pathophysiology Inflammation of the larynx - due to virus or bacteria May cause severe respiratory distress in children under 5 years old -small larynx of the young child - subject to spasm when irritated or infected - becomes partially or totally obstructed Dx thru laryngoscopy to reveal edema, drainage and erythematous laryngeal mucosa

LARYNGITIS Clinical manifestations/assessment Hoarseness Voice loss Scratchy and irritated throat Persistent cough

Assessment Subjective Patient report of: Progressive hoarseness Productive/non-productive cough Exposure to inhaled irritants Objective Evaluate patient’s voice quality Sputum characteristics

DIAGNOSTIC TESTS Laryngoscopy - edema - drainage of vocal cords and laryngeal mucosa

MEDICAL MANAGEMENT Viral—no specific treatment Bacterial—antibiotics Analgesics Antipyretics Antitussives Warm or cool mist vaporizer Limit use of voice

Pain, related to pharyngeal irritation NURSING DIAGNOSES Pain, related to pharyngeal irritation Impaired verbal communication , related to edematous vocal cord Pain level, offer meds & steam inhalation REST VOICE, communicate thru writing, gestures, anticipate pt needs

NURSING INTERVENTIONS Encourage oral intake Encourage adequate rest Use of vaporizer  increase humidity  keep secretions thin and easier to expectorate Medication teaching Avoid exposure to inhaled irritants Preventive measures

PHARYNGITIS Etiology/pathophysiology Inflammation of the pharynx Chronic or acute Frequently accompanies the common cold Viral, most common Bacterial – a severe form of pharyngitis – strep throat It is the most common throat inflammation. Strep throat

PHARYNGITIS Clinical manifestations/assessment Dry cough Tender tonsils Enlarged cervical lymph glands Red, sore throat - scratchy  difficulty swallowing Fever

PHARYNGITIS - Medical Management Antibiotics Penicillin, Erythromycin Treat severe infections Prevent superimposed infections in people with cardiac history Analgesics Antipyretics Warm or cool mist vaporizer

Nursing Interventions/ Patient Teaching Offer throat gargles/rinses Adequate Rest Adequate oral fluids Use of vaporizer Medications: pain meds, antibiotic, antipyretic

Impaired oral mucous membrane, related to edema NURSING DIAGNOSES Impaired oral mucous membrane, related to edema Deficient fluid volume, risk for, related to decreased oral intake as a result of painful swallowing Warm saline, lozenges level of pain, & meds, fluids Observe & record hydration status, I&O, temp, IV therapy if needed

SINUSITIS Etiology/pathophysiology Underlying pathophysiology: Inflammation of the sinuses Usually begins with an upper respiratory infection Viral or bacterial Chronic or acute Underlying pathophysiology: Begins with a URI  sinus infection

SINUSITIS Clinical manifestations Constant, severe headache Pain and tenderness in involved sinus region Purulent exudate Malaise Fever

SINUSITIS Assessment: Subjective: Patient report of: Objective Decrease appetite or nausea Generalized malaise, headache, pain in the sinus region Objective VS – esp. temp Character and amt of drainage

SINUSITIS DIAGNOSTIC TESTS: Sinus Radiographs – reveals cloudy or fluid filled sinuses Transillumination – shining a light in the mouth with the lips closed around it. Infected sinuses will look dark and normal sinuses will transilluminate

MEDICAL MANAGEMENT Surgical interventions: Nasal Windows – - allows better drainage and removal of diseased mucosal tissue Antibiotics Analgesics Antihistamines Vasoconstrictor nasal spray (Afrin)

NURSING INTERVENTIONS/Diagnoses Warm mist vaporizer Warm, moist packs Nursing Diagnoses Ineffective breathing pattern, related to nasal congestion Pain, related to sinus congestion